Decision #66/03 - Type: Workers Compensation
Preamble
A non-oral file review was held on March 26, 2003, at the claimant's request.Issue
Whether or not responsibility should be accepted for the costs of a custom fitted knee brace.Decision
That responsibility should not be accepted for the costs of a custom fitted knee brace.Decision: Unanimous
Background
In February 2002, the claimant filed a claim with the Workers Compensation Board (WCB) for left knee difficulties that she experienced during her employment activities as a nanny. Initially, primary adjudication and Review Office denied the acceptance of the claim but the decision was overturned at the Appeal Commission level. For a complete background of the case leading up to the Appeal Panel's decision, please refer to Decision No. 143/02.In a letter dated December 30, 2002, the claimant's spouse asked whether or not the WCB would authorize the purchase of a knee support device which had been suggested by the attending physician on January 13, 2000. The claimant had tried several different design knee support devices that were available at the pharmacy but none had been suitable. A fitted knee device was suggested but the costs were too expensive for the claimant.
On February 4, 2003, primary adjudication denied the claimant's request for a custom fitted knee brace following consultation with a WCB medical advisor. It was the medical advisor's opinion that there were no objective findings to support the request. On February 22, 2003, the claimant appealed the decision to Review Office.
In a decision dated March 7, 2003, Review Office confirmed that no responsibility could be accepted for the costs of a custom fitted knee brace. Review Office had gone over the attending physician's report to the WCB dated May 6, 2002 which detailed his treatment of the claimant in January and February 2000. The report provided examination findings, test results and treatment recommendations but did not speak of the need for a knee brace. Given the Appeal Panel's ruling that the claimant had recovered from the effects of her compensable injury by February 21, 2000, Review Office believed that there was no basis to authorize the purchase of a custom fitted knee brace for the claimant in the year 2003 in connection with the compensable injury. On March 10, 2003, the claimant appealed Review Office's decision and a non-oral file review was arranged.
Following discussion of the case, the Appeal Panel requested additional information from the claimant's attending physician pertaining to the need for a custom fitted knee brace. A report from the physician was later received dated May 6, 2003 and it was forwarded to the claimant for comment. On May 27, 2003, the Panel met to render its final decision with respect to the issue under appeal.
Reasons
This case involves a worker who injured her knee in a workplace accident. Her application for compensation was not accepted by the board, which decision was upheld by the Review Office. A subsequent appeal to this Commission was successful, as a different Panel found her claim to be acceptable. Benefits were paid accordingly.In that decision, rendered on December 11, 2002, the Appeal Panel also held that, by February 21, 2000, she had recovered from the effects of her workplace injury and that any ongoing problems with her knee were due to a non-compensable injury incurred by the worker.
Shortly after the successful appeal, the claimant sought WCB authorization to purchase a custom fitted knee brace. This was denied on the basis that there was no evidence on file attesting to the need for such a brace. This decision was upheld by Review Office. She then appealed that decision to the Appeal Commission.
For her appeal to be successful, the Panel would have to determine that there is sufficient evidence connecting the need for such a brace to the compensable injury. We were not able to make that determination.
In coming to our decision, we conducted a thorough review of the claim file, as well as seeking further evidence from her attending physician.
We would note that the claimant did not file a claim for compensation until February 2002, some 25 months after the injury. At the time of filing, there was no mention in the reports submitted of the need for a brace. In a letter to the board in May 2002, her doctor reviewed her signs and symptoms when she came in to see him in January 2000 and his subsequent treatment. However, he made no mention of the need for a brace. He also wrote that, since September 2000, she has had no further difficulties with her knee and that she has been able to carry on with duties until the time of writing.
The first mention of a brace occurred in late December 2002, after the first appeal decision. Her doctor wrote her a prescription, on January 6, 2003, calling for a "Left knee brace [with] side support." It does not state that the brace need be custom fitted.
In a "Doctor's Progress Report", dated April 7, 2003, the doctor wrote: "She will need a reinforced brace when climbing stairs or steps."
The first time it is specifically identified that she should have a custom fitted brace is in a letter, dated May 6, 2003 and in response to a letter from the Appeal Panel, in which the doctor wrote: "A prescription was given for the brace and the request was to have a custom design single hinge to help with the weakness and some pain in the left knee."
Other factors which influenced our decision include:
- An x-ray taken in January 2000, at the time she initially reported her knee problem, showed "no significant bone or joint abnormality."
- The findings of the previous Appeal Commission decision, which concluded that she had recovered from the effects of her workplace injury by February 21, 2000.
- The report of a board medical advisor who, after reviewing the file in January 2003, found "no findings reported on file which would indicate the need for a custom brace."
Accordingly, the appeal is dismissed.
Panel Members
T. Sargeant, Presiding OfficerB. Popowich, Commissioner
W. Leake, Commissioner
Recording Secretary, B. Miller
T. Sargeant - Presiding Officer
(on behalf of the panel)
Signed at Winnipeg this 19th day of June, 2003